The aim of this project is to evaluate a gaming simulation designed to increase malaria knowledge and to provide practice with risk appraisal and prevention decision-making. Malaria is an excellent exemplar for a risk reduction intervention due to the expanding range; life-threatening consequences, and the vital need for adherence to personal prevention measures [1-6]. Malaria is resurging and redistributing on a global scale, with 3.2 billion individuals at risk for infection, 350-500 million clinical episodes per year, and 3000 deaths per day [7-11]. Climate and land use changes are amplifying transmission, while lack of a vaccine and development of resistance to anti-malaria drugs and pesticides heighten risk [12-28]. Despite this convergence of risk factors, studies have demonstrated that travelers underestimate malaria risk and fail to adhere to recommendations [29-44]. Study abroad students are in jeopardy due to the rapid expansion of programs in malaria risk regions, the general lack of acquired immunity and malaria knowledge among US citizens, and the developmental feelings of invincibility in a young adult population [45-52]. Preliminary work provided data from a study abroad population about risk representations and personal protection measures for malaria and other travel health risks, and feasibility testing for conducting on-line surveys. These findings and precepts of the self-regulation model (SRM) and the cognitive theory of multimedia learning informed the design of a tailored web-based simulation [53-55]. Evaluation will be conducted using a three arm randomized trial and pre/post assessments to compare different feedback strategies for decisions made during game play. Outcome measures are knowledge, game score, and player satisfaction. Omnibus assessment will use ANCOVA to adjust for pre-intervention knowledge score. ANOVA will be used for the game score and player satisfaction assessments. Tukey-Kramer will be used to examine all pairs of means in the treatment arms. A second tier of analysis will use structural equation modeling to test the direct and mediating effects of SRM cognitive and emotional representational dimensions and prevention self-efficacy on game score and player satisfaction. This program of research addresses NINR objectives by 1) designing/testing an interactive web-based tool to improve self-management, and '2) using evolving technology for on-line data collection and simulation software [56]. [unreadable] [unreadable] [unreadable]